Objective:
To investigate the epidemiological characteristics of septic
cardiomyopathy and explore the relationship between the relevant indexes measured by
echocardiography and the
prognosis of
patients with
sepsis.
Methods:
A
case-control study was conducted. The data of
patients with
sepsis admitted to the department of
critical care medicine of Jiangsu Subei People's
Hospital Affiliated to Yangzhou
University and the department of
critical care medicine of
Beijing Electric
Power Hospital of
State Grid Corporation of
China from June 2018 to June 2021 were enrolled. The general information and 28-day
prognosis were recorded. At the same
time,
ultrasonic parameters obtained by
transthoracic echocardiography within 24 hours after
intensive care unit (ICU) admission were recorded. The differences in ultrasound indexes between the
death group and the
survival group on 28 days were compared.
Parameters with significant statistical differences between the
death group and the
survival group were included in the
Logistic regression analysis to find the independent
risk factors for the
prognosis of
patients with
sepsis, the predictive value of each index for the
prognosis of
patients with
sepsis was evaluated by receiver operator characteristic curve (
ROC curve).
Results:
A total of 145
patients with
sepsis were enrolled, including 106
patients with
septic shock. Among the 145
patients, septic
cardiomyopathy was found in 73
patients, with the
incidence of 50.3%. The
incidence of
left ventricular diastolic dysfunction cardiomyopathy was 41.4% ( n = 60), the
incidence of
left ventricular systolic dysfunction cardiomyopathy was 24.8% ( n = 36), and the
incidence of right ventricular systolic dysfunction
cardiomyopathy was 12.4% ( n = 18). At 28 days, 98
patients survived and 47 died, with the
mortality of 32.4%. The peak e' velocity by
tissue Doppler imaging (e') and right ventricular myocardial systolic tricuspid annulus velocity (RV-Sm) of the
death group were significantly lower than those of the
survival group [e' (cm/s) 7.81±1.12 vs. 8.61±1.02, RV-Sm (cm/s) 12.12±2.04 vs. 13.73±1.74, both P < 0.05], left
ventricular ejection fraction (LVEF) and left ventricular systolic mitral annulus velocity (LV-Sm) in the
death group were slightly higher than those in the
survival group [LVEF 0.550±0.042 vs. 0.548±0.060, LV-Sm (cm/s) 8.92±2.11 vs. 8.23±1.71], without significant differences (both P > 0.05).
Parameters with significant statistical differences between the two groups were included in the
Logistic regression analysis and showed that e' and RV-Sm were independent
risk factors for the 28-day
prognosis of
patients with
sepsis [e'
odds ratio ( OR) = 0.623, 95%
confidence interval (95% CI) was 0.410-0.947, P = 0.027; RV-Sm OR = 0.693, 95% CI was 0.525-0.914, P = 0.010].
ROC curve analysis showed that the area under the
ROC curve (
AUC) of e' for predicting the 28-day
prognosis of
patients with
sepsis was 0.657, 95% CI was 0.532-0.781, P = 0.016, the best cut-off value was 8.65 cm/s, the
sensitivity was 62.1%, and the
specificity was 73.4%. The
AUC of RV-Sm for predicting the 28-day
prognosis of
patients with
sepsis was 0.641, 95% CI was 0.522-0.759, P = 0.030, the best cut-off value was 14.80 cm/s, the
sensitivity was 96.6%, and the
specificity was 26.6%.
Conclusions:
The
incidence of septic
cardiomyopathy is high. The LVEF measured by early
echocardiography has no predictive value for 28-day
prognosis in septic
patients, while RV-Sm and e' are important predictors for 28-day
prognosis.